LETTERS TO THE EDITOR Re: YouTube as a Source of Information About Premature Ejaculation Treatment We would like to compliment Dr Gul and Dr Diri on their important work. YouTube is growing as a first-line resource where patients learn about health-care information, and it is important for physicians to understand the quality of informa- tion available to patients, as it can shape expectations before the clinical encounter. It is refreshing to see that on the subject of premature ejaculation (PE) there is more reliable than unreliable videos available to patients. 1 It is unfortunate that there is no statistically significant dif- ference in average views between reliable and unreliable infor- mation. 1 At the most recent 2019 Sexual Medicine Society of North America conference in Nashville, we presented similar research titled “The Quality of YouTube Videos on Male Hypogonadism.” Although our results differed in that we found most information on male hypogonadism to be of low quality, we similarly found that high-quality videos were not receiving more views. While we agree with Dr Gul and Dr Diri’s conclusion that universities, physicians, and physician organizations should upload high quality content to YouTube, we do not agree that YouTube should be tasked with removing low quality or deceptive videos. It is our belief that this is both unrealistic and potentially dangerous. Considering that 500 hours of content per minute is being uploaded to YouTube, their likely solution for removing harmful content would be through artificial in- telligence that relies on keywords and user reporting. 2 With this type of system, there is a potential for reliable videos to be removed for using keywords in a context that may be acceptable. Physicians should not implore YouTube to censor health-care information; instead, physicians and physician organizations, such as the Sexual Medicine Society of North America, should upload high-quality videos to their own professional YouTube channels. These groups should also work to increase their dis- coverability and view counts, as there is little purpose in making a high-quality patient education video that does not reach the intended audience. According to the YouTube Creator Academy, a channel created by YouTube to help content creators, there are several ways to increase discoverability and viewership. First, a brief and accurate title in combination with a custom thumbnail should be used. 3 A thumbnail is the picture that is alongside a video title when appearing in search. It is important to use a custom thumbnail instead of the one randomly assigned because YouTube is a visually based website and thus the “cover photo” is extremely important in determining if a user clicks on the video. 3 A high contrast, bright photo, with bold font that is at least 1280 Â 720 pixels is recommended. 3 The YouTube Creator Academy also stresses the importance of a thumbnail that portrays the video accurately, as the average user watch time is a heavily favored metric for appearance of videos in the search algorithm. 3 Videos watched longer are located at the top of search and are more likely to be recommended. 3 With average watch time being heavily favored, it is important to use tags that are descriptive and to write a concise synopsis of the video content. 3 This will ensure that the viewers who click on the video are actually interested in the content. Another heavily favored metric in the YouTube algorithm is user engagement. These are things such as likes, comments, and shares. Another way to increase user engagement is by using cards and end screens. 3 Cards are custom frames inserted into videos, such as an interactive poll. End frames appear at the end of the video and the creator can insert links to other videos that may be relevant. They can also add links to their personal website or include the subscription button for their YouTube channel. In conclusion, YouTube is an important source of health-care information for various urological issues. Currently, reliable videos are not attracting more viewers than unreliable videos. Professional urological societies should upload patient education videos to their channels and follow the aforementioned guide- lines to increase viewership to provide a trusted space within YouTube for patient education. Christopher Warren, BA 1 , Boris Paskhover, MD 2 , and Hossein Sadeghi-Nejad, MD 1,3,* 1 Department of Urology, Rutgers-New Jersey Medical School, Newark, USA 2 Department of Otolaryngology, Rutgers-New Jersey Medical School, Newark, USA 3 Department of Urology, Hackensack University Medical Center-Meridian Health, Hackensack, USA Corresponding Author: Hossein Sadeghi-Nejad, MD, 20 Prospect Ave #711, Hackensack, NJ 07601. Tel: (201) 342- 8977; Fax: (201) 342-0623; E-mail: Hossein55@icloud.com Conflicts of Interest: The authors report no conflicts of interest. Funding: None. https://doi.org/10.1016/j.jsxm.2019.11.268 J Sex Med 2020;17:357e358 357 Downloaded from https://academic.oup.com/jsm/article/17/2/357/6973428 by guest on 13 January 2023